JPRAS Open最新文献_第2页

Do not neglect jaw swellings, clinical and radiological view 不要忽视颌骨肿胀，临床和放射学观点

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-19 DOI: 10.1016/j.jpra.2025.12.010

Zilefac Brian Ngokwe, Atanwo Nita Lise Dongmo

引用次数: 0

Quality and accessibility of online patient self-education resources for breast reconstruction 乳房再造患者在线自我教育资源的质量和可及性

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-18 DOI: 10.1016/j.jpra.2025.12.022

Arashk Ghasroddashti , Colm Guyn , Yonatan Fortinsky , Robert Wesley Edmunds , Glykeria Martou

Background

With rising interest in breast reconstruction after mastectomy, patients are increasingly turning to online resources to supplement medical consultations. However, the quality and accessibility of these materials remain inconsistent. This study evaluates the readability, understandability, actionability, content coverage, and transparency of online breast reconstruction resources.

Methods

The top 20 Google search results were examined for five common breast reconstruction-related queries. Metrics assessed included SMOG readability level, PEMAT scores (understandability and actionability), content coverage, and a modified EQIP score for quality. Statistical analyses examined relationships among these variables and with factors like search rank, author type, and query.

Results

Mean content coverage was 49 %, with significant gaps in preoperative planning, treatment side effects, and fat grafting. Readability was poor (mean SMOG 12.3). Understandability was high (80 %), but actionability (37 %) and quality (modEQIP of 40 %) were low. Academic authors produced shorter and lower-quality resources. Higher-ranked resources were generally longer and correlated with better performance across most metrics. Specific queries like ‘DIEP flap’ yielded narrower, lower-quality resources.

Conclusions

Online resources for breast reconstruction are highly variable and often fall short in readability, comprehensiveness, and transparency. Although understandability is generally acceptable, low actionability and inconsistent coverage hinder patient utility. Search engine rank modestly correlates with quality, suggesting some alignment between visibility and value. Improving these resources will require targeted efforts to simplify language, address topic gaps, and enhance actionable content—especially for specialized queries where quality remains lowest.

随着人们对乳房切除术后乳房重建的兴趣日益浓厚，患者越来越多地转向在线资源来补充医疗咨询。然而，这些材料的质量和可获得性仍然不一致。本研究评估在线乳房重建资源的可读性、可理解性、可操作性、内容覆盖率和透明度。方法对排名前20位的谷歌搜索结果进行5个常见的乳房重建相关查询。评估的指标包括烟雾可读性水平、PEMAT分数（可理解性和可操作性）、内容覆盖率和修改后的EQIP质量分数。统计分析检查了这些变量之间的关系，以及与搜索排名、作者类型和查询等因素之间的关系。结果平均内容覆盖率为49%，在术前计划、治疗副作用、脂肪移植等方面存在显著差距。可读性差（平均烟雾指数12.3）。可理解性高（80%），可操作性低（37%），质量低（modEQIP为40%）。学术作者提供的资源较短，质量较低。排名较高的资源通常较长，并且在大多数度量标准中与更好的性能相关。像“DIEP flap”这样的特定查询只能得到更窄、质量更低的资源。结论乳房再造术在线资源变化多端，易读性、全面性和透明度不足。虽然可理解性通常是可接受的，但低可操作性和不一致的覆盖率阻碍了患者的效用。搜索引擎排名与质量适度相关，表明可见性和价值之间存在某种一致性。改进这些资源需要有针对性的努力来简化语言、解决主题差距和增强可操作的内容——特别是对于质量仍然最低的专门查询。

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引用次数: 0

A rare case of supinator syndrome caused by osteofibrous dysplasia of the radius 桡骨骨纤维发育不良引起旋后肌综合征一例

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-18 DOI: 10.1016/j.jpra.2025.12.023

Johannes C. Heinzel , Luisa Lange , Julia Wittlinger , Natalie Winter , Vladyslav Kavaka , Adrien Daigeler , Jonas Kolbenschlag , Henrik Lauer

We report the case of a 57-year-old male who presented to our emergency room due to progressive paresis of the muscles innervated by the deep branch of the radial nerve in the right forearm. The patient suffered from osteofibrous dysplasia and an x-ray revealed the polyostotic disease had also affected his radius. High resolution ultrasound revealed that an exostosis of the radius had caused compression of the posterior interosseous nerve unusually distally in the supinator tunnel. The patient underwent nerve decompression and recovered full strength in his wrist-, and finger extensors approximately 9 months postoperatively. This case report illustrates a case of a rare disease, i.e. osteofibrous dysplasia of the radius, in conjunction with the first published report of an unusually located nerve compression syndrome, i.e. supinator syndrome, caused by this very disease.

我们报告一例57岁男性，因右前臂桡神经深支支配的肌肉进行性麻痹而来到我们的急诊室。患者患有骨纤维结构不良，x光片显示多骨赘病也影响了他的桡骨。高分辨率超声显示桡骨外植瘤导致后骨间神经在旋后肌隧道异常远端受压。术后约9个月，患者行神经减压术，腕关节和手指伸肌完全恢复。本病例报告描述了一例罕见疾病，即桡骨骨纤维结构不良，并结合了首次发表的由该疾病引起的异常位置神经压迫综合征，即旋后肌综合征的报告。

引用次数: 0

Bone complications after hand and face transplantation: Mechanisms and management 手部和面部移植后的骨并发症：机制和处理

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-18 DOI: 10.1016/j.jpra.2025.12.019

Omer Dirican , Bedreddin Sazoglu , Zeynep Demir , Naga Anvesh Kodali , Ramu Janarthanan , Yalcin Kulahci , Fatih Zor , Vijay S. Gorantla

Vascularized composite allotransplantation (VCA) has expanded the frontiers of reconstructive surgery by enabling restoration of form and function in patients with devastating facial and extremity defects. While advances in surgical techniques and immunosuppression have improved short- and mid-term outcomes, bone-related complications remain a critical yet underexplored challenge. This review provides a comprehensive overview of the mechanisms and clinical manifestations of bone problems in VCA, including delayed union, nonunion, avascular necrosis, and osteoporosis. Particular emphasis is placed on the detrimental effects of long-term immunosuppressive therapy on bone metabolism and repair. Current and emerging strategies to address these issues—such as glucocorticoid-sparing regimens, pharmacological therapies like bisphosphonates and teriparatide, and regenerative medicine approaches—are also discussed. By synthesizing clinical experience, translational studies, and experimental models, this review underscores that bone complications represent a major determinant of graft integration, functional recovery, and long-term success in VCA. Greater recognition of these challenges and development of targeted management strategies are essential to optimize outcomes for recipients of bone-containing allotransplants.

血管化复合异体移植（VCA）通过使具有破坏性面部和肢体缺陷的患者恢复形态和功能，扩大了重建手术的前沿。虽然手术技术和免疫抑制的进步改善了短期和中期的预后，但骨相关并发症仍然是一个关键但尚未充分探索的挑战。本文综述了VCA骨问题的机制和临床表现，包括延迟愈合、不愈合、缺血性坏死和骨质疏松。特别强调长期免疫抑制治疗对骨代谢和修复的有害影响。当前和新兴的策略来解决这些问题，如糖皮质激素节约方案，药物治疗，如双膦酸盐和特立帕肽，和再生医学方法，也进行了讨论。通过综合临床经验、转化研究和实验模型，本综述强调骨并发症是VCA移植物整合、功能恢复和长期成功的主要决定因素。更好地认识这些挑战和制定有针对性的管理策略对于优化含骨异体移植接受者的结果至关重要。

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引用次数: 0

Investigation of the therapeutic effect of orbital septum transfer in the reconstruction of severe eyelid defects 眶隔移植修复重度眼睑缺损的疗效观察

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-18 DOI: 10.1016/j.jpra.2025.12.018

Jing Zhou , Jun Chen , Min Zhao , Xiao Song , Yuhong Wang

Objective

To investigate the efficacy of skin flap and orbital septum transfer combined with allogeneic sclera transplantation for the reconstruction of full-thickness eyelid defects after malignant eyelid tumor resection.

Methods

Twenty one patients from our hospital who were diagnosed with malignant tumors of the eyelid through pathological examination and had severe eyelid defects after extensive tumor resection, including eleven patients with eyelid basal cell carcinoma, seven patients with sebaceous gland carcinoma and three patients with squamous cell carcinoma. The tumors were all located on the lower eyelid. The anterior layer was reconstructed using upper eyelid rotational skin flap transfer, while the posterior layer was reconstructed using autologous orbital septum transfer and allogeneic sclera transplantation. After surgery, eyelid closure, eyelid and palpebral margin morphology, transplanted skin condition, local foreign body sensation, and ocular surface condition were observed.

Results

All patients underwent controlled mass resection using specimen-labelled frozen sections during surgery. After that, severe eyelid defects were observed, with one patient undergoing secondary eyelid reconstruction and the remaining patients undergoing primary eyelid reconstruction. After 6-month follow-up, all the patients had satisfactory eyelid closure, satisfactory eyelid and palpebral margin morphology, no local discomfort caused by foreign bodies, smooth orbital septum, good corneal condition on the ocular surface, and no tumor recurrence.

Conclusion

In terms of severe eyelid defects, the use of upper eyelid rotational skin flap transfer to reconstruct the anterior layer, autologous orbital septum transfer, and allogeneic sclera transplantation to reconstruct the posterior layer is safe, effective, and reproducible.

目的探讨眼睑恶性肿瘤切除后皮瓣眶隔移植联合异体巩膜移植修复全层睑缺损的疗效。方法本院21例经病理检查诊断为眼睑恶性肿瘤，经广泛切除后存在严重眼睑缺损的患者，其中眼睑基底细胞癌11例，皮脂腺癌7例，鳞状细胞癌3例。肿瘤均位于下眼睑。采用上睑旋转皮瓣移植重建前层，采用自体眶隔移植和异体巩膜移植重建后层。术后观察眼睑闭合、眼睑及睑缘形态、移植皮肤状况、局部异物感、眼表状况。结果所有患者术中均采用标本标记冷冻切片控制肿块切除。术后眼睑缺损严重，1例患者行二次眼睑重建术，其余患者行一次眼睑重建术。随访6个月，所有患者眼睑闭合满意，眼睑及睑缘形态满意，无异物引起局部不适，眶隔光滑，眼表角膜状况良好，无肿瘤复发。结论对于重度眼睑缺损，采用上睑旋转皮瓣移植重建前睑层、自体眶隔移植重建后睑层、异体巩膜移植重建后睑层安全、有效、可重复性好。

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引用次数: 0

Hijacked highway: A rare case of basal cell carcinoma encasing a cranio-peritoneal shunt 劫持高速公路：一例罕见的基底细胞癌包围颅-腹膜分流

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-18 DOI: 10.1016/j.jpra.2025.12.017

Lisa Davenport , Teresa Y. Liew , Juanita Ling

Background

Metastatic basal cell carcinomas (BCC) are rare. In event of metastasis, BCCs are most likely to spread to the lymph nodes, lungs, bones, and skin. BCC spreading along implanted devices has not been previously documented.

Case presentation

We report a case of a 48-year old man with a head and neck cutaneous BCC involving a cranio-peritoneal shunt, which holds the potential risk of tumor dissemination through this low-resistance pathway. He was followed up over his lifetime to determine if he developed cranial or peritoneal dissemination.

Management and outcomes

A multi-disciplinary team approach was undertaken, a joint case between plastic surgery and neurosurgery was required to secure the shunt and complete a wide local excision. Post-operatively, the patient had adjuvant radiotherapy. The metastatic spread in this case followed the usual pattern of BCC metastasis. The patient developed lung nodules and bone metastases, and died 23 months post-operatively. He did not develop cranial or peritoneal metastases. In this case, the involvement of the shunt did not alter the expected pattern of metastatic spread of BCC.

Conclusion

There is a limited number of case studies that describe implantable devices as a conduit for tumour dissemination.The risk of dissemination did not occur in this case. The long-term follow-up of this case contributes to the literature on decision making in the management of head and neck tumors involving shunts.

背景：转移性基底细胞癌（BCC）是罕见的。如果发生转移，基底细胞癌最可能扩散到淋巴结、肺、骨骼和皮肤。BCC沿植入装置扩散以前没有文献记载。病例介绍：我们报告一例48岁男性头颈部皮肤BCC伴颅-腹膜分流的病例，该病例具有肿瘤通过低阻力途径传播的潜在风险。我们对他进行了终生随访，以确定他是否出现了颅脑或腹膜播散。处理和结果采取了多学科团队的方法，需要整形外科和神经外科联合治疗，以确保分流和完成广泛的局部切除。术后行辅助放疗。本病例的转移扩散遵循BCC转移的通常模式。患者出现肺结节和骨转移，术后23个月死亡。他没有出现颅内或腹膜转移。在这种情况下，转移的介入并没有改变预期的BCC转移扩散模式。结论将植入式装置描述为肿瘤传播渠道的案例研究数量有限。在本病例中没有出现传播风险。该病例的长期随访有助于文献决策的头颈部肿瘤的管理涉及分流。

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引用次数: 0

A systematic review and meta-analysis of soft tissue reconstruction following debridement of tibial osteomyelitis: Comparing muscle and fasciocutaneous flaps 胫骨骨髓炎清创后软组织重建的系统回顾和荟萃分析：比较肌肉和筋膜皮瓣

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-18 DOI: 10.1016/j.jpra.2025.12.012

Nadia Taha , Ibrahim Natalwala , Shafiq Rahman , Gavin Barlow , Cher Bing Chuo

Introduction

Tibial osteomyelitis is a serious condition, often resulting from trauma or orthopedic surgery, frequently requiring soft tissue reconstruction after debridement. This systemic review and meta-analysis compared outcomes of muscle versus fasciocutaneous flap reconstruction following debridement of tibial osteomyelitis.

Methods

Following PRISMA guidelines, MEDLINE, EMBASE, PubMed Central, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched. Prospective or retrospective comparative studies evaluating muscle and fasciocutaneous flap reconstruction following tibial osteomyelitis debridement were included. Non-comparative studies with only one flap type were excluded to reduce bias. Primary outcomes included osteomyelitis recurrence and flap failure; secondary outcomes assessed amputation rates and patient satisfaction.

Results

Six studies encompassing 207 patients (219 flaps) were included. The meta-analysis showed a trend towards lower osteomyelitis recurrence rate in the fasciocutaneous flaps, although this was not statistically significant in one scenario (odds ratio [OR] 3.35, 95 % CI 1.14–9.90 and OR 2.69 95 % CI 0.93–7.74). Significant flap loss rates were comparable, with no statistically significant difference (OR 1.68 95 % CI 0.45–6.25 and OR 1.12 95 % CI 0.30–4.23). Amputation rates were similar between flap types (OR 3.06 95 % CI 0.46–20.38). One study reported higher satisfaction with fasciocutaneous flaps regarding appearance (p = 0.048).

Conclusion

Both flap types effectively support reconstruction in tibial osteomyelitis, providing well-vascularized tissue to help reduce recurrence. Our study focused on the tibia, a bone particularly vulnerable to trauma and devascularization, and identified that muscle and fasciocutaneous flap coverage provided similar clinical outcomes.

胫骨骨髓炎是一种严重的疾病，通常由创伤或骨科手术引起，通常需要在清创后进行软组织重建。本系统综述和荟萃分析比较了胫骨骨髓炎清创后肌肉与筋膜皮瓣重建的结果。方法按照PRISMA指南，检索MEDLINE、EMBASE、PubMed Central和Cochrane Central Register of Controlled Trials （Central）数据库。包括评估胫骨骨髓炎清创后肌肉和筋膜皮瓣重建的前瞻性或回顾性比较研究。排除只有一种皮瓣类型的非比较研究以减少偏倚。主要结局包括骨髓炎复发和皮瓣失效；次要结局评估截肢率和患者满意度。结果纳入6项研究，共207例患者（219个皮瓣）。荟萃分析显示筋膜皮瓣的骨髓炎复发率有降低的趋势，尽管在一种情况下没有统计学意义（比值比[OR] 3.35, 95% CI 1.14-9.90, OR 2.69, 95% CI 0.93-7.74）。显著瓣损率具有可比性，差异无统计学意义（OR 1.68 95% CI 0.45-6.25和OR 1.12 95% CI 0.30-4.23）。不同皮瓣类型的截肢率相似（OR 3.06, 95% CI 0.46-20.38）。一项研究报告筋膜皮瓣对外观的满意度较高（p = 0.048）。结论两种皮瓣均能有效地支持胫骨骨髓炎的重建，提供血管化良好的组织，有助于减少复发。我们的研究重点是胫骨，这是一种特别容易受到创伤和断流的骨骼，并发现肌肉和筋膜皮瓣覆盖提供了相似的临床结果。

{"title":"A systematic review and meta-analysis of soft tissue reconstruction following debridement of tibial osteomyelitis: Comparing muscle and fasciocutaneous flaps","authors":"Nadia Taha , Ibrahim Natalwala , Shafiq Rahman , Gavin Barlow , Cher Bing Chuo","doi":"10.1016/j.jpra.2025.12.012","DOIUrl":"10.1016/j.jpra.2025.12.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Tibial osteomyelitis is a serious condition, often resulting from trauma or orthopedic surgery, frequently requiring soft tissue reconstruction after debridement. This systemic review and meta-analysis compared outcomes of muscle versus fasciocutaneous flap reconstruction following debridement of tibial osteomyelitis.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, MEDLINE, EMBASE, PubMed Central, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched. Prospective or retrospective comparative studies evaluating muscle and fasciocutaneous flap reconstruction following tibial osteomyelitis debridement were included. Non-comparative studies with only one flap type were excluded to reduce bias. Primary outcomes included osteomyelitis recurrence and flap failure; secondary outcomes assessed amputation rates and patient satisfaction.</div></div><div><h3>Results</h3><div>Six studies encompassing 207 patients (219 flaps) were included. The meta-analysis showed a trend towards lower osteomyelitis recurrence rate in the fasciocutaneous flaps, although this was not statistically significant in one scenario (odds ratio [OR] 3.35, 95 % CI 1.14–9.90 and OR 2.69 95 % CI 0.93–7.74). Significant flap loss rates were comparable, with no statistically significant difference (OR 1.68 95 % CI 0.45–6.25 and OR 1.12 95 % CI 0.30–4.23). Amputation rates were similar between flap types (OR 3.06 95 % CI 0.46–20.38). One study reported higher satisfaction with fasciocutaneous flaps regarding appearance (<em>p</em> = 0.048).</div></div><div><h3>Conclusion</h3><div>Both flap types effectively support reconstruction in tibial osteomyelitis, providing well-vascularized tissue to help reduce recurrence. Our study focused on the tibia, a bone particularly vulnerable to trauma and devascularization, and identified that muscle and fasciocutaneous flap coverage provided similar clinical outcomes.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 548-560"},"PeriodicalIF":1.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of flap and contralateral donor site tissue perfusion for flap monitoring in microvascular head and neck reconstruction – a retrospective study 头颈部微血管重建皮瓣与对侧供区组织灌注监测的回顾性研究

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-17 DOI: 10.1016/j.jpra.2025.12.020

Mark Ooms, Philipp Winnand, Marius Heitzer, Nils Vohl, Anna Bock, Marie Sophie Katz, Frank Hölzle, Ali Modabber

Introduction

Postoperative flap monitoring in microvascular head and neck reconstruction based solely on flap tissue perfusion measurements relative to predefined thresholds may be influenced by systemic tissue perfusion alterations. This study compared flap and contralateral donor site tissue perfusion and evaluated the utility of the flap-to-donor site ratio in detecting vascular flap compromise.

Materials & methods

Tissue perfusion measured with the O2C analysis system at a tissue depth of 3 mm at 0, 12, 24, 36, and 48 h postoperatively was retrospectively analyzed in 62 patients who underwent head and neck reconstruction with a fasciocutaneous free flap (FFF) (radial free forearm flap) or a perforator free flap (PFF) (anterolateral thigh flap or fibula free flap) between 2020 and 2022. Flap and contralateral donor site tissue perfusion parameters (blood flow, hemoglobin concentration, and hemoglobin oxygen saturation) were compared, and flap-to-donor site ratio cut-off values indicating vascular flap compromise, based on the minimum (blood flow and hemoglobin oxygen saturation) or maximum (hemoglobin concentration) value of all 5 measurement timepoints, were determined.

Results

Blood flow, hemoglobin concentration, and hemoglobin oxygen saturation were in general higher at the flap than the donor site (p < 0.05). Cut-off values for the flap-to-donor site ratio indicating vascular flap compromise were as follows for FFFs and PFFs, respectively: <1.063 and <0.224 for blood flow, >1.792 and >1.597 for hemoglobin concentration, and <0.673 and <0.199 for hemoglobin oxygen saturation (sensitivity all 100 % [confidence interval (CI) range 2.5–100.0 %]; specificity all >65 % [CI range 49.0–100.0 %]).

Conclusion

The postoperative course of tissue perfusion differs between flap and contralateral donor sites in FFFs and PFFs. The flap-to-donor site ratio could be used to detect vascular flap compromise in microvascular head and neck reconstruction, with further studies needed to confirm the determined cut-off values for the flap-to-donor site ratio indicating vascular flap compromise.

在微血管头颈部重建中，仅基于相对于预定义阈值的皮瓣组织灌注测量的术后皮瓣监测可能受到全身组织灌注改变的影响。本研究比较了皮瓣和对侧供区组织灌注，并评估了皮瓣与供区比值在检测血管皮瓣受损方面的效用。方法回顾性分析2020 - 2022年间62例采用筋膜游离皮瓣（FFF）（桡骨游离前臂皮瓣）或穿支游离皮瓣（PFF）（大腿前外侧皮瓣或腓骨游离皮瓣）行头颈部重建术的患者，在术后0、12、24、36和48 h采用O2C分析系统在组织深度3mm处测量的组织灌注。比较皮瓣和对侧供区组织灌注参数（血流量、血红蛋白浓度和血红蛋白氧饱和度），并根据所有5个测量时间点的最小值（血流量和血红蛋白氧饱和度）或最大值（血红蛋白浓度）确定皮瓣与供区比值临界值，表明血管皮瓣受损。结果皮瓣血流量、血红蛋白浓度、血红蛋白氧饱和度均高于供区（p < 0.05）。对于fff和pff，指示血管瓣妥协的皮瓣与供区比值的截止值分别为：血流<；1.063和<；0.224，血红蛋白浓度>；1.792和>；1.597，血红蛋白氧饱和度<；0.673和<；0.199(敏感性均为100%[置信区间（CI）为2.5 - 100.0%]；特异性均为65% [CI范围49.0 - 100.0%])。结论fff和pff的组织灌注过程在皮瓣和对侧供区之间存在差异。在微血管头颈部重建中，皮瓣与供区比值可用于检测血管瓣的受损情况，皮瓣与供区比值的临界值表示血管瓣受损情况，需要进一步的研究来证实。

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引用次数: 0

Neurolymphatic clearance in neurodegenerative disease: Emerging mechanisms and potential translational strategies 神经退行性疾病的神经淋巴清除：新出现的机制和潜在的转化策略

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-17 DOI: 10.1016/j.jpra.2025.12.013

Adriano Fabi , André S. Alves , Albert Neutzner , Stephan Frank , Ana Lariu , Laurent Muller , Tarek Ismail , Dimitrios G. Gkotsoulias , Raphael Guzman , Dirk J. Schaefer , Nir Grossman , Marc Aurel Busche , Elisabeth A. Kappos

Introduction

Neurolymphatic dysfunction has been linked to cognitive decline and implicated in the pathogenesis of neurodegenerative disorders such as Alzheimer’s Disease (AD) and Parkinson’s Disease (PD). Despite its growing recognition, the potential role of pharmacological or surgical neurolymphatic modulation remains poorly understood.

Objectives

This review summarizes current evidence on the neurolymphatic system’s anatomy, physiology and its involvement in neurodegenerative diseases. It also examines emerging pharmacological and lymphatic reconstructive techniques.

Methods

A comprehensive literature search was conducted in PubMed, yielding 187 studies related to the neurolymphatic system. Studies were screened for the following topics: (1) Anatomy and physiology of the neurolymphatic system, (2) The association between neurolymphatic dysfunction and neurodegenerative diseases, (3) Pharmacological and (4) Microsurgical neurolymphatic modulation.

Results

Current evidence suggests that the neurolymphatic system facilitates drainage of interstitial and cerebrospinal fluid to the deep cervical lymph nodes. Preclinical models suggest that enhancing their clearance may promote the clearance of neurotoxic proteins and potentially improve cognitive function.

Conclusions

Scientific evidence on neurolymphatic modulation in neurodegenerative diseases is scarce. Both pharmacological and microsurgical modulatory techniques remain experimental approaches for neurodegenerative diseases, with a significant potential to improve patients’ quality of life. However, further research is warranted to establish their safety, feasibility, and efficacy. The current knowledge gaps underscore the need for a detailed mapping of the neurolymphatic pathways, preclinical evaluation, and translational interdisciplinary trials.

神经淋巴功能障碍与认知能力下降有关，并与阿尔茨海默病（AD）和帕金森病（PD）等神经退行性疾病的发病机制有关。尽管越来越多的人认识到，药理或外科神经淋巴调节的潜在作用仍然知之甚少。目的综述了神经淋巴系统的解剖学、生理学及其在神经退行性疾病中的作用。它还检查了新兴的药理学和淋巴重建技术。方法在PubMed上进行全面的文献检索，获得187篇与神经淋巴系统相关的研究。研究筛选了以下主题：(1)神经淋巴系统的解剖学和生理学，(2)神经淋巴功能障碍与神经退行性疾病之间的关系，(3)药理学和(4)显微外科神经淋巴调节。结果目前的证据表明，神经淋巴系统促进间质液和脑脊液引流到颈部深部淋巴结。临床前模型表明，增强它们的清除可能促进神经毒性蛋白的清除，并可能改善认知功能。结论神经淋巴调节在神经退行性疾病中的作用尚缺乏科学证据。药理学和显微外科调节技术仍然是神经退行性疾病的实验方法，具有显著的改善患者生活质量的潜力。然而，需要进一步的研究来确定它们的安全性、可行性和有效性。目前的知识差距强调需要详细绘制神经淋巴通路，临床前评估和转化跨学科试验。

{"title":"Neurolymphatic clearance in neurodegenerative disease: Emerging mechanisms and potential translational strategies","authors":"Adriano Fabi , André S. Alves , Albert Neutzner , Stephan Frank , Ana Lariu , Laurent Muller , Tarek Ismail , Dimitrios G. Gkotsoulias , Raphael Guzman , Dirk J. Schaefer , Nir Grossman , Marc Aurel Busche , Elisabeth A. Kappos","doi":"10.1016/j.jpra.2025.12.013","DOIUrl":"10.1016/j.jpra.2025.12.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Neurolymphatic dysfunction has been linked to cognitive decline and implicated in the pathogenesis of neurodegenerative disorders such as Alzheimer’s Disease (AD) and Parkinson’s Disease (PD). Despite its growing recognition, the potential role of pharmacological or surgical neurolymphatic modulation remains poorly understood.</div></div><div><h3>Objectives</h3><div>This review summarizes current evidence on the neurolymphatic system’s anatomy, physiology and its involvement in neurodegenerative diseases. It also examines emerging pharmacological and lymphatic reconstructive techniques.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in PubMed, yielding 187 studies related to the neurolymphatic system. Studies were screened for the following topics: (1) Anatomy and physiology of the neurolymphatic system, (2) The association between neurolymphatic dysfunction and neurodegenerative diseases, (3) Pharmacological and (4) Microsurgical neurolymphatic modulation.</div></div><div><h3>Results</h3><div>Current evidence suggests that the neurolymphatic system facilitates drainage of interstitial and cerebrospinal fluid to the deep cervical lymph nodes. Preclinical models suggest that enhancing their clearance may promote the clearance of neurotoxic proteins and potentially improve cognitive function.</div></div><div><h3>Conclusions</h3><div>Scientific evidence on neurolymphatic modulation in neurodegenerative diseases is scarce. Both pharmacological and microsurgical modulatory techniques remain experimental approaches for neurodegenerative diseases, with a significant potential to improve patients’ quality of life. However, further research is warranted to establish their safety, feasibility, and efficacy. The current knowledge gaps underscore the need for a detailed mapping of the neurolymphatic pathways, preclinical evaluation, and translational interdisciplinary trials.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 438-449"},"PeriodicalIF":1.8,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The hidden mechanism of vacuum bell therapy: Local fat hypertrophy drives cosmetic outcome in adolescents with pectus excavatum 真空钟疗法的隐藏机制：局部脂肪增生驱动青少年漏斗胸美容效果

IF 1.8 Q3 SURGERY

JPRAS Open

Pub Date : 2025-12-14 DOI: 10.1016/j.jpra.2025.12.006

Xiaoyan Feng , Peter Zimmermann , Martin Lacher , Oliver Johannes Deffaa , Nicole Burger , Johanna Pape , Franz Wolfgang Hirsch , Sebastian Krämer , Daniel Gräfe

Purpose

Vacuum bell (VB) therapy is a non-invasive treatment option for pectus excavatum (PE), traditionally considered most effective in children under 12 due to greater skeletal remodeling potential. However, the extent and mechanisms of cosmetic improvement in older adolescents remain poorly understood.

Methods

We retrospectively analyzed 19 male patients (median age 14.8 years) who underwent VB therapy for at least 1 year. Real-time MRI was performed before and after therapy to assess morphological changes. Key parameters included the Haller Index (HI), Correction Index (CI), and pectus excavation depth (PED). Additionally subcutaneous soft tissue thickness was measured at the deformity site and at the lateral thoracic wall.

Results

After a median treatment duration of 1.8 years, HI and CI did not show significant reductions (HI: 5.4 to 5.3, p = 0.40; CI: constant 32 %, p = 0.96), while PED decreased significantly (16.7 mm to 112.7 mm, p = 0.009). Subcutaneous soft tissue at the deformity site increased markedly by a median of 6.5 mm, compared to a 0.5 mm increase at the lateral thoracic wall. Fat-selective T1-weighted Dixon MRI confirmed that the increased subcutaneous tissue consisted of adipose tissue.

Conclusions

The improvement in visual appearance of PE morphology during VB therapy results primarily from localized adipose tissue hypertrophy, while skeletal remodeling is likely to contribute to a much lesser degree. From a cosmetic perspective, these findings might justify the continued use of VB therapy beyond the traditional age threshold.

目的：真空钟（VB）治疗是一种治疗漏斗胸（PE）的非侵入性治疗选择，传统上认为12岁以下儿童因骨骼重塑潜力较大而最有效。然而，对大龄青少年美容改善的程度和机制仍然知之甚少。方法回顾性分析19例接受VB治疗至少1年的男性患者（中位年龄14.8岁）。治疗前后进行实时MRI检查以评估形态学变化。主要参数包括Haller指数（HI）、校正指数（CI）和胸骨挖掘深度（PED）。此外，在畸形部位和胸壁外侧测量皮下软组织厚度。结果中位治疗时间为1.8年后，HI和CI没有明显降低（HI: 5.4 ~ 5.3, p = 0.40； CI：恒定32%，p = 0.96），而PED显著降低（16.7 mm ~ 112.7 mm, p = 0.009）。畸形部位的皮下软组织明显增加6.5 mm，而胸壁外侧增加0.5 mm。脂肪选择性t1加权Dixon MRI证实增加的皮下组织由脂肪组织组成。结论VB治疗期间PE视觉形态的改善主要是由局部脂肪组织肥大引起的，而骨骼重塑可能在较小程度上起作用。从美容的角度来看，这些发现可能证明在传统年龄阈值之后继续使用VB治疗是合理的。

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引用次数: 0